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Mangion A, Ivasic B, Piller N. The Utilization of e-Health in Lymphedema Care: A Narrative Review. Telemed J E Health 2024; 30:331-340. [PMID: 37527411 DOI: 10.1089/tmj.2023.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Background: Electronic health (e-Health), refers to technologies that can be utilized to enhance patient care as well as collect and share health information. e-Health comprises several umbrella terms, including telehealth, mobile health, e-Health, wearables, and artificial intelligence. The types of e-Health technologies being utilized in lymphedema (LE) care are unknown. Method: In this narrative review, a search of published research on the utilization of e-Health technologies in LE-related care was conducted. Results: Five different types of e-Health modalities were found (robotics, artificial intelligence, electronic medical records, smart wearable devices, and instructive online information) spanning 14 use cases and 4 phases of care (preventative, diagnostic, assessment, and treatment phases). Broad e-Health utilization examples were found including robotic-assisted surgery to reduce the likelihood of LE after lymphadenectomy, machine learning to predict patients at risk of filarial-related LE, and a novel wearable device prototype designed to provide lymphatic drainage. Conclusions: e-Health has reported merit in the prevention, diagnoses, assessment, and treatment of LE with utilization demonstrating cutting edge applicability of e-Health for achieving optimal patient care and outcomes. As technology continues to advance, additional research into the utilization of e-Health in LE care is warranted.
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Affiliation(s)
- Andrea Mangion
- Lymphoedema Clinical Research Unit, Flinders University, Adelaide, Australia
| | - Bruno Ivasic
- Lymphoedema Clinical Research Unit, Flinders University, Adelaide, Australia
| | - Neil Piller
- Lymphoedema Clinical Research Unit, Flinders University, Adelaide, Australia
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2
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Zhou XL. Long-term follow-up of comparative study of open and endoscopic lymphadenectomy in patients with penile carcinoma. Surg Endosc 2024; 38:179-185. [PMID: 37950029 PMCID: PMC10776462 DOI: 10.1007/s00464-023-10542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Penile carcinoma is an uncommon cancer that develops in the penis tissue. The standard surgical method to manage regional lymph nodes after local excision is radical inguinal lymphadenectomy, but it has a high rate of complications. The objective of this retrospective study was to compare the long-term outcomes of endoscopic inguinal lymphadenectomy and open inguinal lymphadenectomy in patients with penile carcinoma. METHODS The study included patients diagnosed with penile carcinoma who underwent open inguinal lymphadenectomy (n = 23) or endoscopic inguinal lymphadenectomy (n = 27) at a single hospital between January 2013 and January 2021. Operation time, blood loss, drainage, hospital stay, postoperative complications, and survival rates were assessed and compared between the two groups. RESULTS The two groups were comparable in terms of age, tumor size and stage, inguinal lymph nodes, and follow-up. The endoscopic group had significantly lower blood loss (27.1 ± 1.5 ml vs 55.0 ± 2.7 ml, P < 0.05), shorter drainage time and hospital stay (4.7 ± 1.1 days vs 8.1 ± 2.2 days, and 13.4 ± 1.0 days vs 19 ± 2.0 days, respectively, P < 0.05), and longer operation time compared to the open group (82.2 ± 4.3 min in endoscopic group vs 53.1 ± 2.2 min in open group, P < 0.05). There were significant differences in the incidence of incisional infection, necrosis, and lymphorrhagia in both groups (4 vs 0, 4 vs 0, and 2 vs 0, respectively, P < 0.05). The inguinal lymph node harvested was comparable between the two groups. The mean follow-up time was similar for both groups (60.4 ± 7.7 m vs 59.8 ± 7.3 m), and the recurrence mortality rates were not significantly different. CONCLUSIONS The study shows that both open and endoscopic methods work well for controlling penile carcinoma in the long term. But the endoscopic approach is better because it has fewer severe complications. So, the choice of surgery method might depend on factors like the surgeon's experience, what they like, and what resources are available.
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Affiliation(s)
- Xue-Lu Zhou
- Department of Surgery, Chashan Hospital of Guangdong Medical University, 92 Caihong Road, Chashan Town, Dongguan, 523127, Guangdong, People's Republic of China.
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3
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White J, Mason R, Lawen T, Spooner J, Faria KVM, Rahman F, Ramasamy R. Therapeutic Approaches to Penile Cancer: Standards of Care and Recent Developments. Res Rep Urol 2023; 15:165-174. [PMID: 37288454 PMCID: PMC10243351 DOI: 10.2147/rru.s387228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
Penile cancer is a rare malignancy, most commonly diagnosed in older men, associated with poor outcomes, dramatic decline in quality of life and sexual function. Squamous cell carcinoma is the most common histopathology of penile cancer, accounting for 95% of all cases. Localized, early-stage penile cancer can be effectively managed through penile-sparing techniques in many cases, though advanced stages of penile cancer carry a poor prognosis. Current innovative treatments are exploring the role of targeted therapy, HPV-directed therapy, immune checkpoint inhibitors and adoptive T-cell therapies in treatment and prevention of relapse of penile cancer. Clinical trials are investigating the potential of targeted therapies and immune checkpoint inhibitors in advanced penile cancer. This review examines the current management of penile cancer and highlights future directions in research and treatment.
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Affiliation(s)
- Joshua White
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ross Mason
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Tarek Lawen
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Jesse Spooner
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Kauy V M Faria
- Department of Urology, Institute of Cancer of São Paulo, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Farah Rahman
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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4
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Yang M, Liu Z, Tan Q, Hu X, Liu Y, Wei L, Deng C, Zhou S, Yang N, Duan G, Zheng Y, Li X, Chen Z, Zhou Z, Zheng J. Comparison of antegrade robotic assisted VS laparoscopic inguinal lymphadenectomy for penile cancer. BMC Surg 2023; 23:55. [PMID: 36915083 PMCID: PMC10012593 DOI: 10.1186/s12893-023-01935-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/08/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Minimally invasive modifications of inguinal lymphadenectomy (IL), including laparoscopic IL (LIL) and robotic-assisted IL (RAIL), have been utilized for penile cancer. Comparative study is necessary to guide the decision about which minimally invasive technique to select for IL. Therefore we compared RAIL with LIL performed via an antegrade approach in terms of perioperative outcomes. METHODS We conducted a retrospective study of 43 patients who underwent RAIL (n = 20) or LIL (n = 23) for penile cancer from 2016 to 2020. The key surgical procedures and techniques are described. Complications were graded by the Clavien-Dindo classification, and operative time, estimated blood loss (EBL), lymph nodal yield, nodal positivity, postoperative drain duration, and disease recurrence during follow-up were assessed. Categorical variables were compared using chi-squared whereas continuous variables were compared by t-tests. RESULTS The operative time for RAIL was significantly shorter than that of LIL (median 83 vs 95 min). Significantly less blood loss was reported with RAIL than with LIL (median 10 vs 35 ml). Lymph node yield, pathological positive nodes, the hospital stay, postoperative drain duration, postoperative complications and recurrence were similar for RAIL and LIL. CONCLUSIONS For patients with penile cancer, perioperative outcomes of RAIL and LIL were similar, but there was less blood loss, a shorter operative time for robotic cases.
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Affiliation(s)
- Mengjun Yang
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.,Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Zhicheng Liu
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.,Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Qi Tan
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.,Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Xiaofei Hu
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China.,Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yang Liu
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Ling Wei
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Chunyan Deng
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Shikai Zhou
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Nengrui Yang
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.,Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Guangjie Duan
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yiming Zheng
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Xuemei Li
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Zhiwen Chen
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Zhansong Zhou
- Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China
| | - Ji Zheng
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China. .,Department of Urology, Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University (Army Medical University), Gao Tanyan R`d. 30, Chongqing, 400038, China.
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Nabavizadeh R, Petrinec B, Nabavizadeh B, Singh A, Rawal S, Master V. Inguinal lymph node dissection in the era of minimally invasive surgical technology. Urol Oncol 2023; 41:1-14. [PMID: 32855056 DOI: 10.1016/j.urolonc.2020.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/19/2020] [Accepted: 07/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inguinal lymph node dissection (ILND) is an essential step in both treatment and staging of several malignancies including penile and vulvar cancers. Various open, video endoscopic, and robotic-assisted techniques have been utilized so far. In this review, we aim to describe available minimally invasive surgical approaches for ILND, and review their outcomes and complications. METHODS The PubMed, Wiley Online Library, and Science Direct databases were reviewed in February 2020 to find relevant studies published in English within 2000-2020. FINDINGS There are different minimally invasive platforms available to accomplish dissection of inguinal nodes without jeopardizing oncological results while minimizing postoperative complications. Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy are safe and achieve the same nodal yield, a surrogate metric for oncological adequacy. When compared to open technique, Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy may offer faster postoperative recovery and fewer postoperative complications including wound dehiscence, necrosis, and infection. The relatively high rate and severity of postoperative complications hinders utilization of recommended ILND for oncologic indications. Minimally invasive approaches, using laparoscopic or robotic-assisted platforms, show some promise in reducing the morbidity of this procedure while achieving adequate short and intermediate term oncological outcomes.
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Affiliation(s)
- Reza Nabavizadeh
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | | | - Behnam Nabavizadeh
- Department of Urology, Tehran University of Medical Sciences, Tehran, Iran
| | - Amitabh Singh
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sudhir Rawal
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Viraj Master
- Emory University School of Medicine, Department of Urology, Atlanta, GA.
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Juárez-Soto Á, Canales-Casco N, Quintero-Gómez V, Ruiz-Rosety E, de Paz-Suárez M, Campanario-Pérez R. Modified videoendoscopic inguinal lymphadenectomy through suprafascial approach: Technical description and preliminary surgical outcomes. Actas Urol Esp 2022; 46:456-463. [PMID: 35803871 DOI: 10.1016/j.acuroe.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The videoendoscopic approach to inguinal lymph node dissection (VEIL) has been suggested as an excellent alternative carrying lower morbidity but equivalent oncological control. One of its most difficult steps is the development of an appropriate plane of dissection. A suprafascial approach would allow for better exposure. The objective of this study is to determine the feasibility, in terms of safety and oncological control, of a technical modification to the classical VEIL technique using a suprafascial plane of dissection in an initial series of patients. PATIENTS AND METHODS A single institution retrospective review of patients undergoing VEIL technique using our modified suprafascial approach was conducted. A step-by-step surgical description is provided. Data collected included demographics; comorbid conditions; disease characteristics; intraoperative factors; and postoperative factors. RESULTS A total of 7 patients (12 procedures) were included. Average age was 64.42 years old, and 71.42% of the patients were male. The procedure was performed bilaterally in 71.4% of the cases. Median estimated blood loss was 10 mL (range 10-25). Mean operative time was 185 min (range 120-170). Median number of nodes removed was 10.25 nodes (range 7-11). Only one of the patients (8.3%) experienced a Clavien-Dindo grade IIIa complication requiring delayed percutaneous drainage replacement. Median time until drainage removal was 13 days (range 10-16). Median length of stay was 48 hours but ranged from 24-96 hours within the series. CONCLUSIONS The modified VEIL technique using a suprafascial plane of the dissection, allows a bilateral ILND in highly competitive operative times and with limited morbidity, without compromising its oncological efficacy.
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Affiliation(s)
- Á Juárez-Soto
- Servicio de Urología, Hospital Universitario de Jerez de la Frontera, Cádiz, Spain.
| | - N Canales-Casco
- Servicio de Urología, Hospital Universitario de Jerez de la Frontera, Cádiz, Spain
| | - V Quintero-Gómez
- Servicio de Urología, Hospital Universitario de Jerez de la Frontera, Cádiz, Spain
| | - E Ruiz-Rosety
- Servicio de Urología, Hospital Universitario de Jerez de la Frontera, Cádiz, Spain
| | - M de Paz-Suárez
- Servicio de Urología, Hospital Universitario de Jerez de la Frontera, Cádiz, Spain
| | - R Campanario-Pérez
- Servicio de Urología, Hospital Universitario de Jerez de la Frontera, Cádiz, Spain
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7
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Clinical Application of Noninflating Video-Endoscopic Inguinal Lymph Node Dissection. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8259990. [PMID: 35799632 PMCID: PMC9256332 DOI: 10.1155/2022/8259990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
Objective To assess the safety and efficacy of the application of self-made non-inflating suspension technique in video endoscopic inguinal lymph node dissection (ILND). Methods We collected 8 patients with penile carcinoma who underwent noninflating video-endoscopic ILND in the Department of Urology, the First Affiliated Hospital of Anhui Medical University, from May 2019 to March 2021. Then, surgical duration, blood loss, drainage tube indwelling time, hospital stay, number of dissected lymph nodes, and complications in the patients were analyzed. Results All patients (n = 8) finished the surgery successfully, with an average surgical duration of 125 (105-145) minutes, blood loss of 41 (25-50) mL, indwelling time of drainage tube of 7 (5-12) days, and a hospital stay of 14.8 (9-21) days. Additionally, 8.8 (3-14) left side and 7.3 (2-17) right side lymph nodes were dissected on average. Complications occurred in 3 patients during a perioperative period. The patients were followed up for 6-24 months, and none suffered recurrence or metastasis. Conclusion The efficacy of noninflating video-endoscopic ILND is good. Patients who have undergone the surgery not only have few postoperative complications but also have a good prognosis, suggesting the safety and availability of the clinical application.
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8
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Linfadenectomía inguinal videoendoscópica modificada por abordaje suprafascial: descripción de la técnica y resultados quirúrgicos preliminares. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Subirá-Ríos D, Caño-Velasco J, Moncada-Iribarren I, González-García J, Polanco-Pujol L, Subirá-Rios J, Hernández-Fernández C. Pelvic and inguinal single-site approach: PISA technique. New minimally invasive technique for lymph node dissection in penile cancer. Actas Urol Esp 2022; 46:150-158. [PMID: 35272966 DOI: 10.1016/j.acuroe.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To describe our initial experience with a new minimally invasive inguinal and pelvic single-access laparoscopic approach, for performing lymph node dissection (LND) in penile cancer: the Pelvic and Inguinal Single Access (PISA) technique. MATERIAL AND METHODS 10 patients with different penile squamous cell carcinoma stages (cN0 and ≥pT1G3 or cN1/cN2) were operated by means of the PISA technique, between 2015-2018. Intraoperative frozen section analysis was carried out routinely and if ≥2 inguinal nodes (pN2) or extracapsular nodal extension (pN3) are detected, ipsilateral pelvic LND was performed sequentially as a single-stage procedure and using the same surgical incisions. VARIABLES 30-day PCs, estimated blood loss (EBL), transfusion rate, operative time, time to drainage removal, and length of hospital stay (LOS). Medians and ranges of values for selected variables were reported as descriptive statistics. RESULTS Inguinal LND was bilateral in all cases, and pelvic LND was required in 40%. Total operative time was 120-170 min and median EBL was 66 (30-100) cc. No blood transfusion was required. No intraoperative complications were noted, and postoperative complications rate was 40% (10% major complications-symptomatic inguinal lymphocele). Median LOS was 5.8 (3-10) days. Median time to inguinal drain removal was 4.7 days. Mean number of lymph nodes removed by inguinal LND: 10.25 (8-14). Limited volume retrospective experience from a referral center with short follow-up. Outcomes reported may not be reproducible by surgeons with less experience and skills. CONCLUSIONS PISA is a novel, minimally invasive single-site surgical approach to one stage bilateral inguinal/pelvic LNDs for penile cancer showing a low rate of major complications.
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Affiliation(s)
- D Subirá-Ríos
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Servicio de Urología, Hospital Universitario La Zarzuela, Madrid, Spain.
| | - J Caño-Velasco
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - J González-García
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - L Polanco-Pujol
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Subirá-Rios
- Servicio de Urología, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - C Hernández-Fernández
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Subirá-Ríos D, Caño-Velasco J, Moncada-Iribarren I, González-García J, Polanco-Pujol L, Subirá-Rios J, Hernández-Fernández C. Técnica PISA: nueva técnica mínimamente invasiva de acceso único para la linfadenectomía pélvica e inguinal en el cáncer de pene. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Fankhauser CD, Lee EWC, Issa A, Oliveira P, Lau M, Sangar V, Parnham A. Saphenous-sparing Ascending Video Endoscopic Inguinal Lymph Node Dissection Using a Leg Approach: Surgical Technique and Perioperative and Pathological Outcomes. EUR UROL SUPPL 2021; 35:9-13. [PMID: 34825230 PMCID: PMC8605329 DOI: 10.1016/j.euros.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Open inguinal lymph node dissection (oILND) has high morbidity. Ascending saphenous-sparing video endoscopic ILND (VEILND-AS+) represents a minimally invasive alternative with potential benefits. Objective To describe our VEILND-AS+ technique and compare outcomes to oILND. Design, setting, and participants This was a retrospective cohort study of penile cancer patients. Surgical procedure VEILND-AS+ was performed according to the technique described in the supplementary video. Measurements We compared perioperative and pathological outcomes between the two procedures. Results and limitations In the study cohort of 206 men we performed 40 VEILND-AS+ and 251 oILND procedures. In comparison to oILND, VEILND-AS+ had a longer operation time (185 vs 120 min; p < 0.01) but a shorter hospital stay (2 vs 4 d; p < 0.01). A median of eight resected lymph nodes with a median of one affected node per groin was observed in both groups. Extranodal extension was found in 30% of cases after VEILND-AS+ and 35% after oILND. In both groups the median drainage time was 13 d. Wound infections were observed in 38% of cases after VEILND-AS+ and 27% after oILND (p = 0.19). Skin necrosis or wound breakdown occurred in 0% and 6% of cases after VEILND-AS+ and oILND (p < 0.01), while lymphoceles were drained in 18% and 7% of cases, respectively(p = 0.03). Following VEILND-AS+ and oILND, 20% and 14% of patients, respectively, were referred to a lymph oedema clinic (p < 0.01). Conclusions VEILND-AS+ is a safe procedure and offers shorter hospital stays and possibly a lower risk of skin necrosis and wound breakdown in comparison to oILND. Further improvements in the VEILND-AS+ technique are required to reduce complications associated with dead space and injury to lymphatic vessels. Patient summary For patients undergoing surgery on lymph nodes in the groin, a minimally invasive approach instead of open surgery led to discharge 2 days earlier and may have lower rates of severe wound complications.
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Affiliation(s)
- Christian D Fankhauser
- The Christie NHS Foundation Trusts, Manchester, UK.,Luzerner Kantonsspital, Lucerne, Switzerland.,University of Zurich, Zurich, Switzerland
| | | | | | | | - Maurice Lau
- The Christie NHS Foundation Trusts, Manchester, UK
| | - Vijay Sangar
- The Christie NHS Foundation Trusts, Manchester, UK
| | - Arie Parnham
- The Christie NHS Foundation Trusts, Manchester, UK
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Savoie PH, Morel-Journel N, Murez T, Ferretti L, Rocher L, Fléchon A, Camparo P, Méjean A. [French ccAFU guidelines - update 2020-2022: penile cancer]. Prog Urol 2021; 30:S252-S279. [PMID: 33349426 DOI: 10.1016/s1166-7087(20)30753-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE - To update French oncology guidelines concerning penile cancer. METHODS - Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer to update previous guidelines. Level of evidence was evaluated according to AGREE-II. RESULTS - Epidermoid carcinoma is the most common penile cancer histology. Physical examination is mandatory to define local and inguinal nodal cancer stage. MRI with artificial erection can help to assess deep infiltration in cases of organ-sparing intention. Node negative patients (defined by palpation and imaging) will present micro nodal metastases in up to 25% of cases. Invasive lymph node assessment is thus advocated except for low risk patients. Sentinel node dynamic biopsy is the first line technique. Modified bilateral inguinal lymphadenectomy is an option with higher morbidity. 18-FDG-PET is recommended in patients with palpable nodes. Chest, abdominal and pelvis computerized tomography is an option. Fine needle aspiration (when positive) is an easy way to assess inguinal palpable node pathological involvement. Its results determine the type of lymphadenectomy to be performed (for diagnostic or curative purposes). Treatment is mostly surgical. Free margins status is essential, but it also has to be organ-sparing when possible. Brachytherapy and topic agents can cure in selected cases. Lymph node assessment should be synchronous to the removal of the tumour when possible. Limited inguinal lymph node involvement (pN1 stage) can be cured with the only lymphadenectomy. In case of larger lymph node stage, one should consider multidisciplinary treatment including chemotherapy and inclusion in a trial. CONCLUSIONS - Penile cancer needs demanding surgery to be cured, surrounded by chemotherapy in node positive patients. Lymph nodes involvement is a major prognostic factor. Thus, inguinal node assessment cannot be neglected.
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Affiliation(s)
- P-H Savoie
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon, Cedex 09, France.
| | - N Morel-Journel
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165 chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - T Murez
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier, Cedex 5, France
| | - L Ferretti
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - L Rocher
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, APHP, 157 rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - A Fléchon
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P Camparo
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - A Méjean
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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13
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Bansal D, Chaturvedi S, Maheshwari R, Kumar A. Role of laparoscopy in the era of robotic surgery in urology in developing countries. Indian J Urol 2021; 37:32-41. [PMID: 33850353 PMCID: PMC8033240 DOI: 10.4103/iju.iju_252_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/04/2020] [Accepted: 11/20/2020] [Indexed: 01/07/2023] Open
Abstract
With the rapid expansion of robotic platforms in urology, there is an urgent and unmet need to review its cost and benefits in comparison to the traditional laparoscopy, especially in reference to a developing country. A nonsystematic review of the literature was conducted to compare the outcomes of pure laparoscopic and robot-assisted urologic procedures. Available literature over the past 30 years was reviewed. Robot-assisted surgery and laparoscopy were found to have similar outcomes in the areas of radical prostatectomy, partial and radical nephrectomy, radical cystectomy, retroperitoneal lymph node (LN) dissection, inguinal LN dissection, donor nephrectomy, and kidney transplantation. Robot-assisted surgery was found to be significantly costlier than pure laparoscopy. In the absence of a clear advantage of robot-assisted surgery over pure laparoscopy, lack of widespread availability and the currently prohibitive cost of robotic technology, laparoscopic urological surgery has a definite role in the developing world.
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Affiliation(s)
- Devanshu Bansal
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
| | - Samit Chaturvedi
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
| | - Ruchir Maheshwari
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
| | - Anant Kumar
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
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14
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Teh J, Duncan C, Qu L, Guerra G, Narasimhan V, Pham T, Lawrentschuk N. Inguinal lymph node dissection for penile cancer: a contemporary review. Transl Androl Urol 2020; 9:3210-3218. [PMID: 33457292 PMCID: PMC7807325 DOI: 10.21037/tau.2019.08.37] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Penile cancer is an uncommon disease associated with significant psychological and physical morbidity. Penile cancer has an expectable pattern of spread in a stepwise fashion, from inguinal to pelvic lymph nodes (PLN) then distant spread. Patients with penile cancer have variable survival, with patients with a low burden of nodal metastatic disease having lasting survival with surgical management, however patients with a large amount of locoregional metastatic disease having a worse prognosis. The current management options for patients with metastatic lymph node disease in penile cancer aims to reduce the morbidity associated with radical inguinal lymph node (ILN) surgery with appropriate risk stratification to optimise oncological control of the disease. This article describes current challenges in managing the inguinal region in patients with penile squamous cell carcinoma (SCC).
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Affiliation(s)
- Jiasian Teh
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Centre, Melbourne, Victoria, Australia
| | - Catriona Duncan
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Victoria, Australia
| | - Liang Qu
- Young Urology Researchers Organisation (YURO), Melbourne, Victoria, Australia
| | - Glen Guerra
- Division of Cancer Surgery, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Vignesh Narasimhan
- Division of Cancer Surgery, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Toan Pham
- Division of Cancer Surgery, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Austin Hospital, Melbourne, Victoria, Australia
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15
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Nabavizadeh R, Petrinec B, Necchi A, Tsaur I, Albersen M, Master V. Utility of Minimally Invasive Technology for Inguinal Lymph Node Dissection in Penile Cancer. J Clin Med 2020; 9:jcm9082501. [PMID: 32756502 PMCID: PMC7465352 DOI: 10.3390/jcm9082501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023] Open
Abstract
Our aim is to review the benefits as well as techniques, surgical outcomes, and complications of minimally invasive inguinal lymph node dissection (ILND) for penile cancer. The PubMed, Wiley Online Library, and Science Direct databases were reviewed in March 2020 for relevant studies limited to those published in English and within 2000–2020. Thirty-one articles describing minimally invasive ILND were identified for review. ILND has an important role in both staging and treatment of penile cancer. Minimally invasive technologies have been utilized to perform ILND in penile cancer patients with non-palpable inguinal lymph nodes and intermediate to high-risk primary tumors or patients with unilateral palpable non-fixed inguinal lymph nodes measuring less than 4 cm, including videoscopic endoscopic inguinal lymphadenectomy (VEIL) and robotic videoscopic endoscopic inguinal lymphadenectomy (RVEIL). Current data suggest that VEIL and RVEIL are feasible and safe with minimal intra-operative complications. Perhaps the strongest appeal for the use of minimally-invasive approaches is their faster post-operative recovery and less post-operative complications. As a result, patients can tolerate this procedure better and surgeons can offer surgery to patients who otherwise would not be a candidate or personally willing to undergo surgery. When compared to open technique, VEIL and RVEIL have similar dissected nodal count, a surrogate metric for oncological adequacy, and a none-inferior inguinal recurrence rate. Larger randomized studies are encouraged to investigate long-term outcome and survival rates using these minimally-invasive techniques for ILND.
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Affiliation(s)
- Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA; (B.P.); (V.M.)
- Correspondence: ; Tel.: +1-310-986-0966; Fax: +1-404-778-4231
| | - Benjamin Petrinec
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA; (B.P.); (V.M.)
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medicine Mainz, 55131 Mainz, Germany;
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Viraj Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA; (B.P.); (V.M.)
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16
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Falagario U, Veccia A, Weprin S, Albuquerque EV, Nahas WC, Carrieri G, Pansadoro V, Hampton LJ, Porpiglia F, Autorino R. Robotic-assisted surgery for the treatment of urologic cancers: recent advances. Expert Rev Med Devices 2020; 17:579-590. [PMID: 32342705 DOI: 10.1080/17434440.2020.1762487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION As the medical field is moving toward personalized and tailored approaches, we entered the era of precision surgery for the management of genitourinary cancers1. This is facilitated by the implementation of new technologies, among which robotic surgery stands out for the significant impact in the surgical field over the last two decades. AREAS COVERED This article reviews the latest evidence on robotic surgery for the treatment of urologic cancers, including prostate, kidney, bladder, testis, and penile cancer. Functional and oncologic outcomes, new surgical techniques, new imaging modalities, and new robotic platforms are discussed. EXPERT OPINION Robotic surgery had a growing role in the management of genitourinary cancers over the past 10 years. Despite a lack of high-quality evidence comparing the effectiveness of robotic to open surgery, the robotic approach allowed a larger adoption of a minimally invasive surgical approach, translating into lower surgical morbidity and shorter hospital stay. New robotic platforms might allow to explore novel surgical approaches, and new technologies might facilitate surgical navigation and intraoperative identification of anatomical structures, allowing a more tailored and precise surgery. It is an exciting time for robotic surgery, and upcoming technological advances will offer better outcomes to urologic cancer patients.
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Affiliation(s)
- Ugo Falagario
- Division of Urology, VCU Health System , Richmond, Virginia, USA.,Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia , Foggia, Italy
| | - Alessandro Veccia
- Division of Urology, VCU Health System , Richmond, Virginia, USA.,Urology Unit, ASST Spedali Civili Hospital , Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia , Italy
| | - Samuel Weprin
- Division of Urology, VCU Health System , Richmond, Virginia, USA
| | - Emanuel V Albuquerque
- Divisão De Urologia, Faculdade De Medicina Da Universidade De São Paulo, Instituto Do Câncer De Estado De São Paulo , São Paulo, Brazil
| | - William C Nahas
- Divisão De Urologia, Faculdade De Medicina Da Universidade De São Paulo, Instituto Do Câncer De Estado De São Paulo , São Paulo, Brazil
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia , Foggia, Italy
| | - Vito Pansadoro
- Department of Urology, Vincenzo Pansadoro Foundation , Rome, Italy
| | - Lance J Hampton
- Division of Urology, VCU Health System , Richmond, Virginia, USA
| | - Francesco Porpiglia
- Division of Urology, University of Turin, San Luigi Gonzaga Hospital , Orbassano, Italy
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Cozzi G, Musi G, Ferro M, Prestianni P, Bianchi R, Giulia G, Alessandro MF, Luzzago S, Pennacchioli E, de Cobelli O. Robot-assisted inguinal lymphadenectomy: preliminary experience and perioperative outcomes from an Italian referral center. Ther Adv Urol 2020; 12:1756287220913386. [PMID: 32284736 PMCID: PMC7132788 DOI: 10.1177/1756287220913386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/17/2020] [Indexed: 11/15/2022] Open
Abstract
Background Inguinal lymphadenectomy remains the gold standard for the treatment of inguinal lymph node metastases from penile carcinoma, melanoma, Merkel cell carcinoma, and squamous cell carcinoma (SCC). This procedure is associated with significant complications. In order to reduce morbidity, minimally invasive approaches have been described. We report our preliminary experience with robot-assisted inguinal lymphadenectomies (RAIL). Methods RAIL was performed according to the Sotelo technique. When indicated, a robot-assisted pelvic lymphadenectomy (RAPLND) was performed. We recorded age, sex, comorbidities, baseline oncologic diagnosis, operative time, hospital stay, lymph node yield, complications, time to drain removal, and oncologic outcomes. Results From December 2016 to February 2019, 13 patients underwent RAIL. Median age was 65 years (range: 31-85 years). Primary malignancy was melanoma in five patients, Merkel cell carcinoma in four, dermal duct tumor in one, penile cancer in two, and SCC in one. RAIL was monolateral in 12 cases and bilateral in 1 case. A total of 10 monolateral RAPLNDs were performed; median operative time was 279 min (range: 169-320). Median lymph nodes yield was 11 (range: 2-24) for monolateral RAIL and 9 for monolateral RAPLND (range 2-24). Median hospital stay was 4 days (range: 2-5). No procedure was converted to open. Median follow up was 16 months (range: 5-31). Five Clavien-Dindo grade I complications were recorded. Median time to drain removal was 32.5 days (range 7-65). Three recurrences and two cancer-related deaths were recorded. Conclusions RAIL is feasible and associated with a short hospital stay, with little incidence of perioperative complications.
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Affiliation(s)
- Gabriele Cozzi
- Division of Urology, European Institute of Oncology, IRCCS Via Ripamonti, 435, 20141 Milan, Italy
| | - Gennaro Musi
- Division of Urology, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Matteo Ferro
- Division of Urology, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Pierpaolo Prestianni
- Division of Melanoma and Sarcoma, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Roberto Bianchi
- Division of Urology, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - Garelli Giulia
- Division of Urology, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | | | - Stefano Luzzago
- Division of Urology, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
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18
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Guadagni S, Bianchini M, Palmeri M, Moglia A, Berchiolli RN, Morelli L. HALS, EVAR and robot-assisted surgery as minimally invasive approaches for abdominal aneurysm treatment. J Robot Surg 2019; 14:237-238. [PMID: 31243702 DOI: 10.1007/s11701-019-00987-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 06/17/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Simone Guadagni
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Matteo Bianchini
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Matteo Palmeri
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Andrea Moglia
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | | | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.,EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
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19
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Favorito LA. The future of inguinal Lymphadenecotmy in penile cancer: laparoscopic or robotic? Int Braz J Urol 2019; 45:208-209. [PMID: 31021583 PMCID: PMC6541134 DOI: 10.1590/s1677-5538.ibju.2019.02.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Luciano Alves Favorito
- Unidade de Pesquisa Urogenital da Univ. Estadual do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil.,Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil.,Editor Associado da International Braz J Urol, Rio de Janeiro, RJ, Brasil
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20
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Lymph Node Management in Penile Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42603-7_36-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Protzel C, Hakenberg OW, Spiess PE. Lymph Node Management in Penile Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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